Beliefs about 'stroke' and 'its effects': a study of their association with emotional distress
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Date
2005Author
Townend, Ellen
Metadata
Abstract
Emotional distress (symptoms of depression and anxiety) and emotional
disorders are commonly experienced following stroke and negatively influence
recovery and survival rates. Past research suggests that depressive symptoms are
not directly related to lesion location and are only weakly related to actual
functional and social losses. Patients' own subjective beliefs have been underresearched.
This thesis was developed using cognitive theory, past research on
emotional adaptation to emotional disability and observations from piloting. The
main study aimed to investigate distress and a set of beliefs about 'stroke' and
'its effects', and to longitudinally test associations between specific beliefs and
distress, taking into account relevant background variables. Supplementary
studies aimed to explore emotional distress and disorder and relevant beliefs. A consecutive series of 89 patients, without severe cognitive or
communication impairment, were interviewed one month (baseline) after
admission to a stroke unit and 81 were interviewed again at nine months
(follow-up). In the main study, distress was measured using global Hospital Anxiety and
Depression scale scores. Specific beliefs about 'stroke' and 'its effects'
investigated were: Attributions (Casual controllability, 'Why me?', 'Found
meaning?'); Negative self-evaluations (Acceptance of disability, Negative
identity change, Shame); Beliefs in recovery and recurrence (Recovery locus
of control, Confidence in recovery, Recurrence fear). Background variables
measured were: Demographics, Stroke severity, Disability, Pre-stroke
depression, Social support and Life events. The first supplementary study used the structured clinical interview (SCID) for
DSMIV to assess depressive disorder (major or minor) and common anxiety
disorders (generalised anxiety disorder, agoraphobia, social phobia, post
traumatic stress disorder) and, additionally, as a means for exploring relevant
beliefs. The second supplementary study involved further qualitative interviews with sixty participants at baseline to explore their own experiences
and main concerns. Associations were found between distress and most belief variables at
baseline, follow-up and across time. Backward linear regression analyses for
distress were used to study belief variables taking background variables into
account. At baseline and follow-up these analyses supported the statistical
significance of associations between distress and negative self-evaluative
beliefs and recurrence fear. Across time, a role for causal controllability and
acceptance of disability was supported. However, these results also
highlighted the pervasive influence of a pre-stroke history of depression and of
initial distress levels across time. The SCID interview identified that many patients met criteria for depressive
disorder (33% at one and 30% at nine months) or anxiety disorder (35% at one
and 33% at nine months) but also yielded information regarding specific
stroke-related beliefs relevant to distress versus adaptation. The qualitative
interviews provided insight into patients' idiosyncratic concerns. This
extended the main findings, for example by illustrating the varied nature of
recurrence fear beliefs and highlighting individuals' needs to give as well as
receive social support. The SCID interview identified that many patients met criteria for depressive
disorder (33% at one and 30% at nine months) or anxiety disorder (35% at one
and 33% at nine months) but also yielded information regarding specific
stroke-related beliefs relevant to distress versus adaptation. The qualitative
interviews provided insight into patients' idiosyncratic concerns. This
extended the main findings, for example by illustrating the varied nature of
recurrence fear beliefs and highlighting individuals' needs to give as well as
receive social support. Emotional distress (symptoms of depression and anxiety) and emotional
disorders are commonly experienced following stroke and negatively influence
recovery and survival rates. Past research suggests that depressive symptoms are
not directly related to lesion location and are only weakly related to actual
functional and social losses. Patients' own subjective beliefs have been underresearched.
This thesis was developed using cognitive theory, past research on
emotional adaptation to emotional disability and observations from piloting. The
main study aimed to investigate distress and a set of beliefs about 'stroke' and
'its effects', and to longitudinally test associations between specific beliefs and
distress, taking into account relevant background variables. Supplementary
studies aimed to explore emotional distress and disorder and relevant beliefs. A consecutive series of 89 patients, without severe cognitive or
communication impairment, were interviewed one month (baseline) after
admission to a stroke unit and 81 were interviewed again at nine months
(follow-up). In the main study, distress was measured using global Hospital Anxiety and
Depression scale scores. Specific beliefs about 'stroke' and 'its effects'
investigated were: Attributions (Casual controllability, 'Why me?', 'Found
meaning?'); Negative self-evaluations (Acceptance of disability, Negative
identity change, Shame); Beliefs in recovery and recurrence (Recovery locus
of control, Confidence in recovery, Recurrence fear). Background variables
measured were: Demographics, Stroke severity, Disability, Pre-stroke
depression, Social support and Life events. The first supplementary study used the structured clinical interview (SCID) for
DSMIV to assess depressive disorder (major or minor) and common anxiety
disorders (generalised anxiety disorder, agoraphobia, social phobia, post
traumatic stress disorder) and, additionally, as a means for exploring relevant
beliefs. The second supplementary study involved further qualitative interviews with sixty participants at baseline to explore their own experiences
and main concerns. Associations were found between distress and most belief variables at
baseline, follow-up and across time. Backward linear regression analyses for
distress were used to study belief variables taking background variables into
account. At baseline and follow-up these analyses supported the statistical
significance of associations between distress and negative self-evaluative
beliefs and recurrence fear. Across time, a role for causal controllability and
acceptance of disability was supported. However, these results also
highlighted the pervasive influence of a pre-stroke history of depression and of
initial distress levels across time. The SCID interview identified that many patients met criteria for depressive
disorder (33% at one and 30% at nine months) or anxiety disorder (35% at one
and 33% at nine months) but also yielded information regarding specific
stroke-related beliefs relevant to distress versus adaptation. The qualitative
interviews provided insight into patients' idiosyncratic concerns. This
extended the main findings, for example by illustrating the varied nature of
recurrence fear beliefs and highlighting individuals' needs to give as well as
receive social support. This study provides qualified support for cognitive theory of distress
following stroke by demonstrating associations between distress and beliefs
concerning 'stroke' and 'its effects' in the short- and longer-term aftermath of
stroke. Over and above measures of disability, a personal sense of being
unable to accept reduced capability, which some went so far to describe as
'uselessness', was related to higher levels of distress and disorder. Fear of
recurrent stroke was common. Belief in the controllability of risk factors
tended to be low; however a greater initial sense of causal controllability
appeared protective against distress across time. These results have
implications for the development of interventions to address the high
prevalence of emotional distress and disorder following stroke.